Healthcare Provider Details

I. General information

NPI: 1376998864
Provider Name (Legal Business Name): BRINITI ICHULL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E LATHAM AVE STE C
HEMET CA
92543-4409
US

IV. Provider business mailing address

PSC 474 BOX 6501
FPO AP
96351-0066
US

V. Phone/Fax

Practice location:
  • Phone: 951-766-8008
  • Fax: 949-202-0360
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90136
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: